Reading of the Week: Dr. Kurdyak’s Paper on Psychiatry and Practice

A few months ago, a patient walked into my office and immediately broke down. He explained that he had waited so long to see a psychiatrist that he was overwhelmed to finally meet me. For the record, he had never spoken to me before and knew nothing about me – except that I was a psychiatrist and that he needed to see one.

The surprise is that anyone would be surprised by such a story.

Patients often face long wait lists in our health care system. The wait for psychiatric care seems particularly long. But here’s the question: do we have a shortage of psychiatrists in Ontario – or do we have a shortage of creative thinking on how psychiatrists practice in Ontario? The week’s Reading asks this important question, with a surprising conclusion: “increasing psychiatrist supply will have little impact on patients’ access.” Continue reading

Reading of the Week: “36 minutes and 40 seconds”

Cat Stevens’ Tea For The Tillerman is a short album.

11 songs. 36 minutes and 40 seconds. In 2003, Rolling Stone included it in its 500 Greatest Albums of All Time. In 2007, the album was included in The Definitive 200 Albums of All Time. It has appeared in many other lists compiled by sages of the music industry.

And it is the last album my father ever heard.

On Oct 8, 2003, Michael John Hasler (I rarely say his name— it’s nice to type it here) died by suicide. He’d been listening to the CD, which was now still and quiet in the portable stereo close by.

This week’s Reading is a short essay by comedian and playwright Sadie Hasler on the death of her father a dozen years ago, which appears in the latest issue of The Lancet Psychiatry. Continue reading

Reading of the Week: Germanwings, Depression and Violence

Is depression linked to violence? And if it is, what are the clinical implications? This Reading of the Week asks these two questions.

On the Germanwings’ Tragedy

Certainly in light of recent events, the depression-violence link is much discussed. Some have already weighed in. Consider this incredibly offensive newspaper front page.

“Madman.” “Crazed.” And if only that sort of language was restricted to tabloids. Last week, French Prime Minister Manuel Valls said: “everything is pointing towards an act that we can’t describe: criminal, crazy, suicidal.” It’s enough to make us nostalgic for the Sarkozy administration. (Who would have predicted such nostalgia three years ago?)

To be clear, though coverage has been breathless, little is known. In a thoughtful piece in The Atlantic titled “Depressed Doesn’t Mean Dangerous,” Julie Beck notes: “What evidence we have of Lubitz’s mental health or lack thereof is still scant.” Indeed, we can’t answer the most basic questions. Was the ill-fated flight’s co-pilot in active treatment for depression? Was he on medications? What was his mental state in the days leading up to the tragedy? Continue reading

Reading of the Week: Paying Pregnant Women to Stop Smoking

This cigarette-package warning label is short, thoughtful, and completely backed by science.

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Unfortunately, many Canadian women – statistically, 1 in 10 – ignore it and so much other health information, continuing to smoke when pregnant.

What can be done?

Corporate boards give CEOs bonuses when their companies are profitable. Governments (like Canada’s) award athletes with money when they win Olympic medals. Universities give scholarships for academic achievements. So, should we give financial incentives to pregnant women who stop smoking? A recently published British Medical Journal paper suggests that we should. And this controversial paper is the Reading of the Week. Continue reading

Reading of the Week: Dr. Lieberman’s Shrinks

A few years ago, a well-known celebrity — let’s call him Mr. Conway — reluctantly brought his twenty-two-year-old daughter to see me. Elena had taken a leave of absence from Yale, Mr. Conway explained, because of issues surrounding a mysterious drop in her grades. Mrs. Conway nodded assent and added that Elena’s slacking off stemmed from “a lack of motivation and low self-confidence.”
In response to their daughter’s perceived troubles, the Conways had hired a parade of motivational experts, life coaches, and tutors. Despite this pricey coterie of handlers, her behavior failed to improve. In fact, one tutor even volunteered (rather hesitantly, given Mr. Conway’s celebrity) that “something is wrong with Elena.” The Conways dismissed the tutor’s concern as an excuse for his own incompetence and continued to look for ways to help their daughter “snap out of her funk.”

They turned to naturopathic agents and meditation, and when those didn’t help, they shelled out more money for hypnosis and acupuncture. In fact, they had done everything possible to avoid seeing a psychiatrist until “the incident.”

So begins Dr. Jeffrey A. Lieberman’s new book, Shrinks: The Untold Story of Psychiatry. Written with Ogi Ogas, the volume has just been published by Little, Brown and Company.

Dr. Jeffrey Lieberman Continue reading

Reading of the Week: Ending Chronic Homelessness

Can we end chronic homelessness?

Just a few years ago, that question would have seemed absurd. Chronic homelessness was, well, chronic. Today, a re-think of an old problem is yielding incredible results. And here’s the best part: Canadian researchers and the Mental Health Commission of Canada are playing crucial roles.

Continue reading

Reading of the Week: Bring Back The Asylum ?!?

Forget the cutting-edge diagnostic imaging and genetics, is this the future of psychiatry?

Toronto Lunatic Asylum, 1868

A new paper argues that it should be. And it’s created a fire-storm of controversy. Continue reading

Reading of the Week: Recession and Suicide

“This is all I have left.”

My patient, faced with significant financial issues, reached into his pocket and pulled out some change. “Everything else is gone,” he said.

The year was 2010. My patient had spent decades managing a GM dealership but, with widespread company problems, he lost his job and the dealership closed. He described to me walking out one evening with an appointment book filled with future meetings only to realize the next day that he had nothing to do. “I’m an adrenalin junkie.” The long 12-hour work days were replaced by the uncomfortable monotony of unemployment. My patient was lost — and depressed and suicidal. Continue reading

Reading of the Week: Alcohol and Withdrawal

On the Reading of the Week

As we did last month with the benzodiazepine papers, the selection of this week’s Reading was made with the editorial board of the International Psychiatry Twitter Journal Club, allowing us to consider this paper here, and to continue the conversation on Twitter. And that conversation is going on today.

Bonus: the paper’s first author is participating in the Twitter discussion. And Dr. Maldonado will be presenting unpublished data, too. #Cool. Continue reading

Reading of the Week: Dr. Doidge and Neuroplasticity

First he noticed it was becoming hard to sing, a nightmare because that was how he made his living and singing was who he was. Then he could barely sing at all but could still speak his lines. And then over a couple of years he began to lose his speaking voice, until it became wispy thin and trailed off, so that he could generate only short, barely audible bursts of whispered air.

“It was agonizing to watch him lose his beautiful singing voice, heartbreaking. I fell in love with that voice,” said Patsy Husmann, his wife of 50 years.

Years ago, I was invited to a dinner party. I found myself seated at a table with a noted poet, a New York Times bestselling author, a Toronto psychoanalyst, the former editor of a smart literary review, and an award-winning essayist. All these people were named Dr. Norman Doidge. Continue reading